Background The prevalence of concomitant depression among cancer survivors is not well established, although half of those diagnosed with cancer are reported to experience depression at some stage during the cancer experience.
Objectives To establish rates of diagnosed depression in a cohort of nonelderly adult cancer survivors by cancer site, to characterize those with diagnosed depression, and to assess the impact of diagnosed depression on patterns of health care utilization and costs.
Methods Medical and pharmacy claims data on military health care beneficiaries were used to develop a cohort of survivors across all cancer sites. Selected cases were diagnosed with and treated for cancer in fiscal years 2006-2007, and had at least 1 health care claim each subsequent year through fiscal year 2010 to ensure survival of at least 2 years. All cancer sites were included except those for nonmelanoma skin cancer. Fiscal year 2009 was used as the index year for determining annual health care utilization and costs. Bivariate and regression analyses were used.
Results Across the cohort of 11,014 cancer survivors, 12.6% had a comorbid diagnosis of depression at the time of or after a cancer diagnosis. The highest rates of diagnosed depression occurred in those with cancers of the esophagus, pancreas, ovary, or bronchus, lung, or other respiratory organ; and were associated with female sex, single marital status, and enlisted sponsor rank. Survivors who were diagnosed with depression had significantly higher health care utilization for inpatient and outpatient services, more medication prescriptions, and higher annual costs.
Limitations Due to the nature of claims data, we were unable to ascertain cancer stage or phase of illness. In this analysis, we did not include the presence of comorbidities, history of preexisting depression, or health system factors, all of which may impact the rate of depression among cancer survivors.
Conclusions The findings suggest the importance for the Military Health System, as well as other health care systems, to address the mental health needs of cancer survivors and the fiscal efficiencies of cancer care.
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